An early start to success!

Sometimes, people will reach out to me while they're still in medical school -- or still in an undergraduate program -- trying to figure out what changes to make now in order to have better future outcomes when applying to residency programs. While everyone's situation is unique, there are some common themes that the most successful residency applicants typically share:

1) Leadership versus membership. While a long list of activities might look appealing on the surface, can you point to any of them and say that you did more than attend meetings and events? Serving as an officer of a group can add some depth to your application, since that usually includes steering the direction of your organization, handling interpersonal conflicts, collaborating with other student leaders as well as faculty members, etc. Having said that, active membership is at least better than passive membership; if you include an organization or team on your application, you should be able to speak about the group's mission, what inspired you to join, and what you participated in during your time. In other words, don't pad your application with something that isn't meaningful to you; it can backfire.

2) Initiation versus continuation. Whether it's a research project, student club, or social awareness project, you'll most often find yourself taking a path that others have already taken before you, such as participating in an annual event that doesn't change much from year to year, or helping out for a few hours per week in some ongoing bench research. That's still great, and you should continue that activity! But if you've developed a great connection with a faculty advisor, or noticed a lack of campus awareness on a particular topic, maybe you can start something new. Off the top of my head, there might be a general student chemistry interest group, but maybe they never seem to have any speakers on the sub-topic of environmental chemistry. Can you talk to the current student leadership about planning a focused event about it? Or if you have a potential research project in mind, think about how being a coauthor of a presentation, publication, or poster would also be a nice boost for your application. Can you think of a faculty member who might share your vision, especially one who could write you a valuable letter of support when you eventually apply?

3) Communicating versus resume-building. Sometimes people spend so much time trying to fill their application with the right blend of experiences that they never think about the next step. In order to secure the internship, graduate program, or other position you're looking for, what's on your CV/resume will crack open the door for you, but the interview is crucial for demonstrating that you belong. How well can you articulate what first got you interested in the field, what you hope to accomplish as a member of their team, and what you hope to do in the future? Are you comfortable making eye contact while talking, speaking about yourself without being too boastful or self-deprecating, and avoiding the conversational fillers of "like" and "umm"? Consider how you can develop your public speaking skills.

4) Targeting versus generalizing. You'll probably be looking at various organizations for internships, as well as multiple graduate programs for the next phase of your education. Try go beyond the general topic of "I want to find a great job/education" by including something specific, customized for your target audience. Take the time to read their website, particularly if there's a letter of introduction from the department head, as that can give you some real insight into the type of person they're looking for. This is useful for both the cover letter to your application, as well as the interview itself. It demonstrates that you aren't just applying broadly, but that you chose this particular college/hospital/company/etc for a reason, and that you're able to discuss that rationale. Yes, it takes more time to customize your approach for every potential position...and your prospective boss will notice that you took the time when so many other applicants didn't!

5) Specificity versus commonality. It's useful to show that in addition to having the general characteristics that someone might be looking for, you go beyond that by sharing what sets you apart from the competition. Does your personal or professional history give you a perspective that other applicants might lack? For example, did your early exposure to the sciences through your parents inspire you to make certain choices in college? Additionally, if there are any flaws in your application, how can you turn them around and present them as strengths? (I once had a client with dyslexia who needed extra time to get through medical school, and her grades suffered -- but when her patients need her to explain things multiple times to them or they have trouble following a medical regimen, she thinks back to her personal history and tries to care for others the way she would want to be helped in that situation. I'm sure she's an amazing primary care physician.)

I hope this was helpful! If you share a CV/resume with me, I can try to offer more focused advice. Also, if you really are in medical school or even still in college, I want to give you a lot of credit for starting this process so early; this gives you the time to make changes and enhance your status as a future applicant. Most people reach out to me after they graduated and failed to find success on their own. I can help them present and reframe their past experiences, but of course they can't go back in time and make different choices; they're stuck with the limited activities and professional connections that they made before they ever contacted me. Maybe the advice above will help you make changes right now!

Changes to ERAS for 2023-2024

I've been helping medical students and graduates apply to residency programs through ERAS since 2001, and over the years, there have been a variety of changes. The "dean's letter" changed to the Medical Student Performance Evaluation, which went beyond a simple name shift to a restructuring of the format and content of the document. The USMLE Step 2 CS exam was introduced, used for many years to examine clinical skills in a performance-based setting, and then during the pandemic, it faded away. But other than the means of transmitting ERAS documents changing from physical disks to web-based, the application itself had typically seen only smaller, iterative changes, until now.

I encourage all of you to click and read "What’s New in the 2024 MyERAS® Application" to get a detailed explanation of the upcoming changes. But the modifications that caught my attention include:

1) A limit of ten experiences in ERAS. Although some applications will barely change as a result, this will be a seismic shift for some other applicants (although an outlier, a new client applied on their own last year without matching, and had a staggering 31 experiences listed at the time, which I believe makes it difficult for program directors to focus on what is most important to you). In related news, applicants will be able to select the three experiences within those ten that are most meaningful to them, and add a brief explanation as to why.

2) In prior years, experiences had to be clustered under "Work", "Volunteer", or "Research", and at times those distinctions felt arbitrary. This year, the list has been expanded to:
* Work
* Research
* Volunteer/Service/Advocacy
* Education/Training
* Military Service
* Other Extracurricular Activity/Club/Hobby
* Professional Organization
* Teaching/Mentoring

It appears that the old "Hobbies & Interests" section has been removed this year. But there are still ERAS sections titled "Other Awards/Accomplishments" and "Membership in Honorary/Professional Societies", so given the limit of ten experiences total, some applicants may consider removing conference participation as an experience to make room for a potentially more relevant clinical endeavor. 

3) There won't be a supplemental ERAS application for 2023-2024, but many of this year's changes were inspired by that previous application component. For example:
* Additional details about each experience can be provided, including the setting (such as urban versus suburban versus rural), participation frequency, the primary focus area, and the key characteristic.
* If desired, applicants can share certain preferences with programs, including a shortlist of programs that they would truly like to interview at, as well as a subset of geographical locations that are of particular interest, and/or the setting that they would like to train in. This will help the programs tell if an applicant applied to their region, or potentially to that particular hospital, for a reason that might elevate their standing with that interview committee.

If you've previously applied on your own without success and are worried about how to update your application for the new ERAS season, or if this will be your first time and you're worried that you might not stand out in a crowd of applicants, I encourage you to reach out to me for a free consultation. I would be happy to evaluate your residency documents and then schedule a conversation with you.

Is it safe to double-apply?

Clients often ask me if it's safe to apply to more than one specialty, particularly if it's at the same hospital. There are pros and cons to this, so I'll mention right away that I will not be giving you an absolute answer.

1) Officially, programs don't know where else you applied, either in their specialty, or if you applied to any other specialties. ERAS does not release this information to them at all, so typically there's no danger in double-applying, as long as you never lie about it. But you can't control all information; what if you accidentally sent your FM personal statement to an IM program, or one of your letter writers got a follow-up phone call and accidentally mentioned the wrong specialty? So never volunteer the information that you double-applied, but if a program director asks if you applied to any other field besides theirs, assume that somehow they already know. In that specific situation, say something like "My heart belongs to [your specialty], but at the advice of my residency advisor, I applied to a handful of programs in [other specialty] since I have connections there, and I didn't want to risk not matching. But I'm here today to talk about [your specialty]."

2) Unofficially, you have no control of what happens to your application after you transmit it through ERAS. Many years ago, I heard a story about two program directors meeting for lunch, and as one was running late, the other pulled out an application to review. When the late one arrived he recognized the name on the folder as an applicant to his own specialty. I have no idea if this is a true story, but it's believable. But if I go back even further to when I was still at UCSF, I have a real story to share. One of my students double-applied and got interviews in both specialties at the same hospital. During her second hospital tour (remember that pre-pandemic, all interviews were in person), she bumped into a resident she had met during her first interview! Thankfully, she had never lied during either interview; by not claiming that either was the only specialty she had chosen, she didn't feel she had broken her word.

3) Family medicine and internal medicine applications are often intertwined for applicants due to their high interest in primary care, as well as the fact that the specialties are seen as IMG-friendly. Based on what I've seen over the past 15 years, family medicine is the most IMG-friendly specialty, and if it's already your top choice then it's worth considering if you still want to double-apply. But there's little harm in applying to two specialties. Also, personal connections count for a lot, and if you know people who have matched in both specialties then by all means apply to those specific programs, in the hopes that your friends can put in a good word for you.

4) How has the pandemic affected your medical education? Quite a few of my clients have reported that their experience in internal medicine rotations was quite limited due to COVID-19, with most of their patient interactions happening in an outpatient or telemedicine setting. That may not be the best reflection of your experience in that specialty! I would hate for you to spend lots of money applying, only to be ignored during interview season because of a situation that was out of your control.

5) Your personal statement should be customized for each specialty. Again using family medicine and internal medicine as an example, there's going to be a great deal of overlap between them due to the primary care components, but they should not be identical. Of course if the two specialties you've chosen have less overlap, you'll need to write two very different documents; for example your internal medicine essay might focus on your diagnostic skills, but your psychiatry essay would likely have a different story that highlights your ability to build rapport with patients.

6) Some letter writers act like letters of recommendation are a burden, despite the fact that they needed LORs when they applied to residency themselves! So if you're double-applying, you need to find out if they prefer to write and upload a single letter that's good for any specialty ("She would be a superb resident in the field of her choice"), or if they are willing to write and upload two LORs with lots of overlap, but with some unique sentences ("She would be a superb family physician" / "She would be a superb internist"). Keep in mind that as the applicant, you might be asked to draft the letter(s) yourself! That's extra work for you.

7) Though you should use different personal statements and might get different LORs depending on the specialty, there's only one ERAS application. For some applicants, double-applying can "dilute" your application. It's less of an issue with FM and IM, since primary care fields are so interconnected, but years ago I had an applicant who wanted to apply in surgery and psychiatry. Every surgery experience mentioned mental health; every psychiatry reference mentioned similarities between physical and emotional scars. In my opinion, it felt really forced and didn't seem work in his favor, but he didn't listen to my advice about choosing a single specialty; his writing style seemed to hurt him when it came to the number of interviews he received.

8) Many specialties are using the supplemental ERAS application this year (it's optional but recommended). Family medicine is not using it, but if you're also applying in internal medicine, pediatrics, psychiatry, or many other specialties, that's yet another task you need to accomplish. The main ERAS application should optimally be finished by the day before the target application date of September 28, but the supplemental application is due by September 16, so that's yet another task you need to complete.

Best of luck with your application!

How many programs?

Potential clients frequently ask me how many programs they should apply to, but there's no easy answer, and in fact this is one of the few topics that I specifically mention in my contract that I don't handle. Even if I had attended medical school, earned the same grades and USMLE results as you did, and participated in the same experiences, I might approach the problem very differently. I don't think there's a right number, or a good number, or a safe number for any specialty. But if I were a typical IMG interested in family medicine and internal medicine, I might apply:

* To every hospital where I had rotated or completed an externship

* To every hospital where my friends are current residents in one or both of these departments

* To every hospital where my letter writers have professional colleagues in one or both of these departments

* To every hospital where my family and friends have a connection in one or both of these departments

* To every hospital where I've already had good discussions with program representatives (for example if you attended the national AAFP conference in July)

Beyond that? Any other program you pick is your choice, but the less connected you are to it based on the criteria above, the program directors might be less likely to give your application the attention it deserves. If you want to add to your list, first consider how IMG-friendly it is (are there lots of residents from schools like yours in those departments?), and then maybe if it fits other criteria you're looking for (underserved area? rural vs urban?). It's hard to say if simply living in the same state as a program normally helps, but a bilingual applicant from a border state ought to be able to demonstrate their connection to patients in that region.

So your first attempt at creating a list might have 20 programs, but it might have 200. The quantity doesn't matter to me...though it certainly might matter to you! Do you know how expensive ERAS is? After you pick your first 30 programs in a certain specialty (which isn't too expensive), ERAS starts charging you a lot more per program, and the fees add up quickly. They published an online list of fees that I recommend reviewing. 200 programs in your first choice specialty would cost almost $5000.

Applying to more places doesn't automatically get you more interviews, especially if you're seeking out programs that seem out of reach. Because every program director assesses your application separately, then sure, there's a chance at additional invitations, but if you're picking programs that are less IMG-friendly or where no Caribbean student has ever matched before, you could just be throwing money away. I strongly encourage you to contact your medical school and review their match success lists, and talk to former classmates to not only find out where they applied, but where they received interview offers. Use free resources like FREIDA and Residency Explorer to focus your search. Review program websites to see their lists of current residents; do they seem IMG-friendly? Additionally, IMGs from some schools can't get licensed in certain states; it's your responsibility to research this, because these restrictions won't stop ERAS from accepting your money.

Finally, I strongly recommend you sit down with a trusted attending to see what they think about this message and what they can do to help you get interviewed. If you need help actually preparing your application documents, getting ready for interviews, and the overall Match process, please contact me!

SOAP during the pandemic

In December 2020, the AAMC's Chief Medical Education Officer announced she had seen "a maldistribution of residency interview applications" (or to rephrase this like one of my clients did, "interview hoarding"). In short, this meant that top-tier American applicants were accepting far more interview offers than ever, presumably because it was cheap and easy to interview virtually, instead of the normal practice of taking time off from rotations and paying to fly around the country for in-person interviews. Unfortunately, this hoarding led to IMGs missing out on interviews that they might have otherwise received, since some residency committees were so happy that these American graduates wanted to interview at their lower-tier programs, and didn't bother to interview as many IMGs as they usually did. 

But those committees didn't realize that these American graduates weren't likely to rank those programs highly, so they probably won't match there. If those same programs didn't interview enough IMGs to fill the bottom of their rank lists, they might have unfilled positions, which could be a great opportunity for residency applicants like you.

This year, Match Week begins on Monday, March 15, which is when you will find out if you matched, but not where. The week concludes on Match Day (Friday, March 19), when the name of the program you matched to is revealed. In between those two dates is the "Supplemental Offer & Acceptance Program," better known as SOAP. During that week, eligible unmatched applicants can apply for free to a total of 45 programs (it's your choice if you want to apply to all 45 in one specialty, or spread that out among multiple fields, but you can't pay ERAS to apply to more than 45 during SOAP). Be thoughtful about where you apply, and consider following the SOAP advice I've previously posted. For the first time ever, the NRMP has added a fourth "round" when programs will make offers to applicants, so it's more crucial than ever to be prepared for a quick interview during Match Week.

If you don't match next week, either through the main process or during SOAP, please don't give up hope! This was an incredibly tough year for applicants, due to the disruption of USMLE exams (particularly Step 2 CS), and the loss of many in-person training opportunities. I have more than twenty years of experience supporting medical students and graduates, particularly focusing on the needs of the IMG community. I would love the opportunity to help you achieve your dreams. After I review your ERAS application, personal statement, USMLE history, and other aspects of your application, I can try to help you succeed when you reapply next time. I offer a free consultation to all potential clients, so please contact me!

Virtual interviewing

The AAMC has published an Applicant Preparation Guide with a variety of helpful ideas for interviewing virtually during this pandemic, and I certainly recommend reading it carefully. I also have a few additional suggestions:

1) If you're using your laptop, get an Ethernet cable to plug it directly into the router, instead of using Wi-Fi. The signal strength is much stronger and more consistent when using a physical cable! That's what I have, and this is the most valuable suggestion I can make. (also ask other people in your home to avoid using the internet during your interview, if possible)

2) Good lighting helps, as does the location of the lighting. Depending on how your room is set up, you might consider moving to a different spot to take advantage of (or avoid) light from the window. You can also put a small lamp on your desk.

3) Spinning fans directly overhead can be very distracting, and also use up bandwidth as your computer tries to process the image. Also, consider what else might be visible behind you during a virtual interview.

4) If your laptop is an older model with a low quality camera, you should consider investing in an external webcam.

5) There are settings within certain programs that might enhance your use of a high definition camera, if you have one. For example on Zoom you would go to the settings, then click "Video" and finally the checkbox for "HD". However, this uses more bandwidth, and can paradoxically make your connection worse, so test it with a friend in advance.

The AAMC guide has much more information than what I just wrote above, so please read it carefully; I just wanted to supplement it with some other ideas. Good luck!

September 1 is not a deadline during COVID!

There's a lot of confusion about application dates, so I want to say this as clearly as possible:
September 1 is not an application deadline, so you do not need to submit anything through ERAS that day. 

It's true that you could certify and submit your application on September 1, but there's no benefit, and potentially you might limit yourself. For example, imagine if you submit your application that day, but then you want to add something new before the programs can read it? Too bad; there's no way to do that. For example, if in the first week of October you suddenly participate in a one-day health fair, but you already certified and submitted your ERAS application, there would be no way to add that as a new Volunteer Experience. 

October 21 is the actual first day that program directors can download your ERAS application this year, and all applicants should be completely finished well before that date arrives. Here is some helpful information about the schedule. You can see there that the residency programs can't start reviewing applications until October 21, even if they were submitted much sooner. (In case you're thinking that the date "September 15" is important, in the years before the pandemic, that's when programs could review your application; this year for the first time it was changed to October 21)

To use an analogy, imagine that you're standing in line at the U.S. Post Office, with your application in a sealed and stamped envelope. Applying on the very first day would put a September 1 postmark on your application, and that's when your application would get mailed to the program directors. But then the envelope would sit in a pile for a month and a half, gathering dust. The program directors can't open the envelope until October 21, and all the envelopes will get opened on the same day, whether they were mailed on September 1, October 21, or any day in between. Also, according to the schedule link above, "Applications submitted on or before Oct. 21 will display an application date of “October 21” to programs" -- so the programs won't even know that you tried to submit your application early.

As for the NRMP, that's almost completely unrelated. ERAS transmits your documents to program directors (who can't read them until October 21), but the NRMP coordinates the Match in February / March 2021. Although you should register early with the NRMP to get the best price, the Match is not something to worry about right now. By the way, the Personal Information section of ERAS is the only part of the application that can be changed after you certify it, which means you can update details like your address, ACLS certification, and your NRMP identification number. But your Experiences, Publications, Education and almost everything else can't be changed after you certify and submit your application.

In summary, don't rush to finish everything this week! Take the time to finish your application the right way. As always, please contact me if you have any questions about the residency application process. I am happy to provide a free assessment of your application. I have twenty years of experience in helping people develop their personal statements and ERAS applications, prepare for interviews, learn about what residency directors will think of their strengths and weaknesses, and much more! 

Applying for residency during a pandemic

As we start the second month of sheltering in place (at least where I live), I've been thinking a lot about how COVID-19 will affect medical graduates who want to apply for residency in September 2020.

If you're reading this, you're probably unsure about your chance of matching. USMLE test dates have been postponed, externships and observerships will be more limited for at least a few months, many in-person networking opportunities have vanished, and in general, residency goals may feel more out of reach than ever.

But since every applicant will be in the same situation, you shouldn't give up on your dreams. More than ever, it's important to seek out opportunities to get appropriate work, volunteer, and research experience so you don't have big chronological gaps, and then to use those experiences in your ERAS application and personal statement to increase the possibility of getting interviewed.

I offer a free consultation to all potential clients (American graduates as well as IMGs), so please reach out to me. I will offer an honest assessment of whether I think you ought to apply or delay, potential steps you can take to enhance your application documents, and if I think I'm the right person to help. I hope to provide you with the same level of support that I have given to medical students and graduates for the past twenty years, even during these turbulent times. Please stay safe, and I hope to hear from you soon.

SOAP advice

Unfortunately, not everyone who applies for a residency position will match, and it's particularly difficult for IMGs. My own clients have a very high success rate, but I've never had a year when they all matched. With that in mind, I encourage each of them to prepare for SOAP, even if they had multiple interviews and feel "safe" about their chances. Here are some of the suggestions I share with them:

* Have you participated in a new externship, observership, research project, volunteer experience, or something else noteworthy since you originally applied? Perhaps you can request a new LOR and have it uploaded into ERAS. You're still only allowed to send four LORs to each program, but they don't need to be the same set of four you used in September.

* Did you get a new USMLE result? The residency programs might not have your most recent scores, so go to the Additional Documents section of ERAS and look for USMLE Transcript. While there, click the action to "Resend" your scores. This will transmit any new scores (including information about recent failed attempts) to all programs you apply to during SOAP, as well as the programs you previously applied to.

* If you were still in medical school when you originally applied in September, you probably have new grades on your transcript, so consider having the latest version uploaded to ERAS. If you ask, some medical deans will even add the newest evaluations to your MSPE and then help you get it uploaded to ERAS.

* Whatever you do, remember that the ERAS/ECFMG upload process can be quite slow, so please act quickly to be ready far in advance of SOAP!

* You're limited to 45 applications during SOAP, in any specialty. That number is fixed regardless of whether you apply to one specialty only, or a mix of specialties. While you are technically allowed to apply to some programs on the first day of SOAP and hold back some other applications until later in the week, I've never known that to be a winning strategy, so I suggest applying to all 45 on Monday.

* Try to be somewhere with a strong (wired not wireless) internet connection, as both the ERAS and NRMP websites will feel glacially slow with thousands of people logging in at once.

* Contact your advisors as soon as you find out that you need to use SOAP so they know what's going on. However, there are NRMP policies that greatly restrict contact with programs, so familiarize yourself with those.

If you didn't match and can't find a program through SOAP, I encourage you to get in touch with me - we can work together in the coming year to help you find the residency program you've been dreaming of!

"Ghost" stories

I recently read this article in Barron's:
https://www.barrons.com/articles/job-applicant-ghosting-51547761704

It reminded me of a few situations I've heard about over the years. The first happened approximately fifteen years ago (while I was still working at the medical school, and before I started Residency Support). It was interview season, and a program director called our dean of students. One of our medical students had never arrived for his scheduled interview. Had there been an accident? Was he okay?

It turned out that this student had decided he had enough interview offers, and that he had chosen to skip this one. But he never contacted the program coordinator or director to cancel (which would have given them enough time to invite a different applicant to take his interview slot). Instead, he found himself face-to-face with our dean, and she was angry. This student, soon to graduate from our medical school, had displayed unprofessional behavior that reflected poorly on all of us. She could have added a note about this to his MSPE, and had me transmit an updated version of the document to all of the programs he had applied to. She could have contacted this student's potential program directors across the country to let them know what had happened so they could factor that into their ranking decisions. This student was very lucky that "ghosting" one program didn't have more serious repercussions.

I recognize that most of you reading this are IMGs, and you would never think about skipping an interview, because it's so hard to get enough interview invitations at all! But there are other types of "ghosting" that happen when applying, and some are your own bad behaviors.

For example, after you asked an attending, a resident, or a friend for help with writing a letter of recommendation or reading a draft of your personal statement, did you thank them? Did you ever ask them if they needed any help from you? I've heard from numerous advisors how disappointed they are when applicants treat the advising/support relationship as one way, and never offer anything in return. Maybe your advisor is struggling with a survey design, or could use a medical student's perspective about an upcoming meeting. The other issue that's been mentioned to me quite a few times is how after Match Day, you might never tell your attendings that you matched, because it didn't occur to you to reach out. But why should an attending write LORs year after year, only to never learn that their hard work paid off?

Finally, programs often "ghost" applicants during the application phase, particularly IMGs. You might apply to 100 programs and receive 10 interview offers, 30 rejections...and get no reply at all from the other 60 programs. It's just as rude when a program "ghosts" you, and you feel completely powerless. Thankfully, I've had some success over the years by helping my clients appropriately follow up with programs after they apply, and sometimes changing their lack of reply to an actual interview invitation. It's not easy, and there are wrong ways to contact programs that can violate AAMC or NRMP policy, but sometimes it pays off! Please contact me to see if I might be the right resource for you and your residency dreams.

Adding value to your application

With the NRMP Match and SOAP starting in just a few minutes, my thoughts turn to the applicants out there who are about to get bad news, and how to help them when they reapply.

A friend recently shared this article about medical students not having the manual dexterity that they used to, which means that their surgical skills aren't as strong. It led me to think about the experiences people list on their residency applications. Of course, you should mention the basics: volunteering in the community, student leadership, externships and observerships, relevant jobs, research, and language skills. But beyond that, what are you demonstrating (or failing to demonstrate) with your choice of hobbies and activities?

If you're going to practice primary care, have you explored that through community involvement? If you're a future surgeon, are you extending your dexterity by playing piano, knitting, or even juggling? In other words, what do you have to offer beyond your rotations, grades, and USMLE scores? How can you set yourself apart from other applicants in order to get noticed by the people who make interview decisions?

In an early blog post, I described the value of joining a committee during your pre-clinical years. But since most of you reading this are at the end of medical school and possibly just after not matching, it's worth thinking about similar activities you can participate in at that level. For example, join a professional organization dedicated to your specialty. From the American College of Obstetricians and Gynecologists to the American Psychiatric Association to the American Academy of Family Physicians, most of these associations welcome student/graduate members (although you should be aware that there are fees). Participating in their activities and conferences can be a great way to learn about your chosen field, and every year some of my clients get interviews due to connections they made through these groups.

As always, I encourage you to reach out to me for a free consultation. If you have trouble matching and need to reapply next year, please let me know if I can help.

Preliminary programs

Last year, some clients had failed to match on their own, and wanted to get it right on their second attempt, so they chose to hire me. That happens every year, but what was unusual was that several of them were considering applying to PGY-1 programs only (preliminary medicine, preliminary surgery and transitional year programs), without planning to apply to a categorical or advanced field.

After supporting medical students and graduates since 2001, including working almost exclusively with IMGs for the past ten years, I understand the desire to match somewhere, anywhere, just to get a toehold in a hospital and try to build a career out of that. But even in a desperate situation like this, I still don't recommend a preliminary training year by itself for most people, especially not preliminary surgery, which typically has the most openings during SOAP.

The reason is that it's sort of like a stepping stone that leads nowhere you want to go. Let's say that what you really think you'd be best at is family medicine, but you didn't match on your own last year. Typically, the people who need to complete a preliminary year do so because their final specialty requires it, like anesthesiology or radiology. That's who the program directors are looking to hire; in fact, when you apply to a preliminary field, ERAS asks you to designate the advanced specialty you eventually hope to train in.

If you were to do a preliminary year, what skills would you develop during that time that would help you as a family physician? It might be good preparation for some aspects of Step 3, and I suppose you'd get some new LORs out of it, but even those letters might be too surgery-focused and not say anything that most family medicine program directors want to hear.

Beyond that, you would still need to reapply through ERAS if you still wanted to complete FM residency training...but when and how would you do that? The life of a PGY-1 in surgery is supposedly pretty brutal, and would you have time to complete your FM application and then go on all of your interviews while on your feet in surgery 80 hours per week? If you take too much time off from preliminary training, you won't even be able to count on a strong recommendation from your program director, and will end up weaker than if you had never done the PGY-1 year at all.

Please contact me if I can provide any more information. I am happy to provide a free assessment of your application, and develop a plan for your future. I can help you develop your personal statement and CV, advise you about your strengths and weaknesses, and much more!

The residency couples match

Are you applying as a couple through the residency match? Do you feel confused about how to combine your rank lists? The NRMP algorithm works very smoothly for a couples match, although it is a bit complicated, so I've put together a sample list with some useful details. In this version, the letters of the alphabet each stand for programs, and "partner" is the other half of your couple (it could be a spouse, fiancé, domestic partner, or even a friend; you do not need to have a legal relationship in order to participate in the couples match). You'll also note that I haven't mentioned specialty choices; that's because for the purposes of the NMRP algorithm in this situation, it doesn't matter. So here's a quick look at a potential rank list:

You Partner
A        A
B        B
A        B
B        A
C        A
C        B
A        D
B        D
A      none
B      none
none    A
none    B

In this sample list, you were both interviewed by programs A and B (again, whether it was in the same specialty or in different specialties does not matter here). Only you were interviewed at C, and only your partner was interviewed at D. If you both successfully match into A, then you've matched, and if you didn't *both* match there, the algorithm looks at the next combination, which is this case is both of you at program B. But if that doesn't happen either, you've instructed the algorithm to check if you matched into A and your partner at B, then check if you matched into B and your partner to A, and so on. At the bottom of the list are situations where one of you matched into one of your two favorite programs, deliberately choosing to leave the other one unmatched.

I could have added several more combinations (such as C-D, none-D, and C-none) to the list, but in short, the couples match only works in pairs. You both need to match at a pre-determined combination of your choosing, even if that combination includes one of you not matching anywhere. The match algorithm doesn't care about specialty or location. (Hypothetically, you could design a couples match to deliberately be in different programs on different sides of the country!)

It can be harder to match as a couple in the sense that one of you could drag the other down. Let's say that you only submitted my sample list above with no additions. If you could have matched at C and your partner could have matched at D, but you didn't include that combination (maybe because they were in different cities), you would both end up unmatched. Or if you could have matched at C solo but your partner was never going to match no matter what, there's no combination listed that allows that to happen, so you would both end up unmatched. So to avoid risking anything due to the couples match, if you put every possible combination including each potential where one of you goes unmatched, then if one of you wasn't going to match no matter what, the other will still be able to match.

Going deeper into detail about that, it's worth noting that neither of your lists gets priority; you both need to fit a particular combination for the couples match to work. For a solo match, the algorithm only looks at the top program on your list without risking anything below. Either the condition is met that you match there, or the program filled with other candidates and only then would the algorithm look at the second position on your list, and so on and so on. But for a couples match, *both* of you need to meet the condition that you match to the combination in your top joint match, and either you both succeed or else the algorithm proceeds to the second combination, and so on and so on. 

Also, there's a potential that one of you might "drag the other down" in the sense that one of you might have matched into a better program applying solo. Looking back to the first three lines of my original sample list:

You Partner
A        A
B        B
A        B

If you truly wanted to train at A more than anyplace else in the world, but your partner doesn't match at A, the algorithm would then look at B-B. If you both match there, you'll both be happy in the sense that you'll be training at the same place. But you might be wondering if you would have matched at A on your own, and you might secretly feel like you just were dragged down...but you will never know it for sure. Hopefully that will not become a source of tension for the two of you. That's the only significant downside to a couples match.

Finally, I don't claim that this blog post is an exhaustive list of details about the couples match, merely a helpful perspective on what actually happens. For the official information, please visit the NRMP website.

Switching programs or specialties

What happens if you matched at one of your least-favorite programs? What happens if you matched into your second-choice specialty? Is it possible to transfer?

Matching anywhere isn't easy, so congratulations to everyone who received good news on Match Day! But maybe it's not the result that you dreamed of. For example, you interviewed at a dozen family medicine programs, but matched into your last choice. Or you really wanted to train in anesthesiology, but matched into your backup specialty of internal medicine instead. Or you were chosen for a position after using SOAP, but it's not what you were hoping for at all.

I want to strongly caution you: reapplying might hurt you more than it helps, unless you are very careful. Remember, if you leave, that will create a vacancy in your current program, and if your program director wants to fill it starting next summer, that means he/she has to interview people this year -- at the same time you're applying and interviewing. And if you don't match into a new program, but your program director finds someone, how does that get resolved? It might mean that your contract doesn't get renewed. That's why you and your director need to work this out together before you start applying (or you decide not to reapply, which is usually the best option). In short, would you prefer to complete your training where you already matched, or risk getting discharged after your first year and then not have anywhere new to train?

If you're absolutely determined to reapply, it's incredibly important to have the support of your new program director, and you should get most (perhaps all) of your LORs from your new attendings. After all, you didn't match into the particular program/specialty you desired with your old LORs, so you need to upgrade them to have a better chance. Plus, applying without the backing of your current program would look suspicious. If you don't use any LORs from your current program, you'll still need to include your current program's contact information in ERAS, and if I were a residency committee reviewing your application, that would be my first email or phone call. I can't imagine most applicants successfully transferring to a new residency program without the support of their current training program.

If you can't tell by now, I think that trying to switch is usually not worth the risk. But if you are completely convinced that you need a change, you should sit down with your program director to talk about the situation before you apply or even work on any documents. You would need a very flexible schedule so you can travel for interviews; the other residents will need to pick up the slack when you're not there, and that might cause some tension. If you take too much time off for interviews and second look visits, you might even be violating the terms of your residency contract! Being honest and upfront about this now will help you and your program director develop a good plan. But it also might convince you to stay where you matched and make the best of it, instead of trying to switch before ever giving your program a real chance.

If you need more information, please contact me for a free consultation.

September 15 is not an application deadline!

(an update of something I posted back in 2012)

September 15 is *not* the ERAS application deadline! Although it is the first day that you can send out your applications, you are not required to do so. Residency program directors will be downloading applications throughout the rest of the month until they can retrieve the MSPEs on October 1, and quite possibly even beyond that date. I know that some programs don't even log into ERAS on the 15th, partially because the system can be incredibly slow on the first day.

Multiple clients and even some non-clients have been asking for advice recently, wondering what to do if their USMLE Step 2 results aren't ready yet. If waiting until September 16th or 17th will make a difference, you can certainly delay your application, and apply with a more complete set of documents all at once. You won't be seen as "late".

Similarly, several people asked what to do about a letter of recommendation that still wasn't available in ERAS. In this case, it might benefit you to send out your application on the 15th without that missing LOR. A late LOR doesn't typically reflect poorly on you; program directors know that even if you request something months in advance, sometimes your attendings just get really busy or distracted. However, you will need to go back into ERAS again to manually assign that LOR to every program that you want to receive it. It's more work for you, but it enables you to get the rest of your application out faster, if it's ready.

Yet there are many other potential applicants who are not ready, and are wondering if they should apply at all. If you're juggling too many things, like final rotations, observerships, research projects, and studying for Step 2CK, then this application may feel like another burden that you're not ready for, particularly if you've never had it professionally reviewed. Many potential applicants should not apply this year, and instead should focus on doing well on their exams and their clinical experiences. People who try to do everything all at once and then don't match get stuck the next year reapplying with lower USMLE scores and weaker LORs from attendings who weren't as impressed as they might have been. Do you really want to spend all of your money on applications this year that have so little chance of success? It's better to develop a strategy for what you should do in the coming months to continue developing your clinical skills, adding relevant experiences to your application, and putting yourself in a position of strength for next year.

There is no general advice that works for all applicants, and a blog like this can't possibly cover all situations. My suggestions for your particular situation might even disagree with what I just wrote above, depending on various factors. Please contact me for advice, preferably sharing copies of documents like your personal statement, LORs, ERAS application, and MSPE, and I'll do my best to give you some personalized guidance.

Letters of intent

As you prepare your NRMP rank list, it can be very helpful to send your final thoughts to the program directors you met. You were able to start working on your online rank list on January 15, 2015, and you need to finish that process by February 25. Residency directors have the exact same date range to develop rank lists, so this is an ideal time to write to them.

A great way to approach this letter is to write it from the perspective of having finished all of your interviews. You're looking back, thinking about all of the programs you visited and people you met. Why does this particular program stand out for you? Why exactly do you want to train there? What should the residency director realize that you have to offer the team at that program?

Do *not* tell multiple programs that they are your number one choice. Although NRMP rank lists are never made public and it may seem safe, lying to a residency program could be discovered quite easily if a program has ranked you high enough that you would have automatically matched there had your statement been true. Residency committee members can have long memories, and when you are applying to fellowship or attending positions, submitting articles to journals where they serve as reviewers, attending conferences, or interacting with them in other capacities, I would hate for them to remember you in a negative light. It's even possible for the program where you *did* match to discover that you had lied to other prospective program directors, leading to an uncomfortable discussion about ethics.

If you send this letter via email, and you're wondering what to use as the subject line, many of my clients use one of these:

• letter of intent
• letter of interest
• ranking plans

(There's no official rule about what to title the email, so if you want to use something different, that's fine. Many people don't pay close attention to subject lines anyway.)

The Waiting Game

You certified your rank list last month, and now you're anxiously awaiting your Match results. You're hopeful or worried, but most of all, you're determined to succeed and want to be prepared. What can you do?

1) Update your personal statement. You don't need to make sweeping changes, but you wrote this back in the summer or fall. What have you done since then that you wish the residency directors knew about you? Remember, your ERAS Common Application Form is certified, meaning that it can't be changed or updated in any way. So if you have recently completed an observership or externship, had a paper accepted for publication, participated in a volunteer experience, or learned a new language, adding a new paragraph just before the conclusion of your personal statement might be the best way to share this information. Try starting with "Recently, I..."

2) Transmit your newest USMLE scores. Since you originally applied, perhaps you finally took Step 2 (or if you're an international graduate, Step 3). Depending on the options you checked in ERAS last fall, the residency programs might not have your most recent scores. If you think that's the case, go to the Documents section of ERAS and look for the USMLE Transcript tab. Open that page, then click to "Retransmit" your scores, which will also transmit any new scores (as well as information about recent failed attempts) to all of your programs.

3) Transmit your updated medical school transcript, and maybe even a newer MSPE. If you're still in medical school, you were probably disappointed that so few grades and evaluations appeared on your original school documents when you first applied. Have a copy of your current transcript scanned into ERAS (after checking it for accuracy, of course), usually through your medical school's Registrar. After that, talk to your dean's office, and find out the policy for having an addendum added to your original MSPE. The addition of your newest evaluations might boost the value of your application...if your dean's office can prepare the addendum quickly.

4) Consider getting the support that you need for SOAP or during next year's match. I would be happy to assess your candidacy for residency, so please contact me for a free consultation. Share some information about your application and interviews with me, and also include your personal statement, CAF, list of USMLE scores and attempts, and LORs and MSPE if you have access to them.

United States clinical experience can make the difference

One of my clients recently asked when he should try to schedule observerships in the United States. He thought that because residency interviews don't usually start until October, and might not happen until January, there was no reason to fly to the United States until August at the earliest. But I'll tell you why I disagree. Residency directors think that United States clinical experience (USCE) is incredibly valuable, much more than the training you get in your home country. Even if you would only be an observer here but back home you were allowed to carry your own patients, it's still important to have some USCE on your application, and the earlier, the better.

Timing is crucial. If you're applying to the 2014 Match, you'll be submitting your application in September 2013. If you don't complete your observership until the end of August, there's a good chance that your LOR won't be ready at the time you apply. Remember that your attending has to make time to write the LOR (or will ask you to create a rough draft), and then the letter needs to be processed by the ECFMG. Just like USCE compared to international experience, an American LOR is more valuable. Residency directors trust these letters and they will increase the value of your application.

Of course, USCE in September or even later is better than none at all. If your upcoming observership has been confirmed but has not yet started when your certify your Common Application Form in ERAS, you might consider adding that upcoming training to your CAF. You will need to be very clear that it has not started yet, and never lie about it. If you have not received a confirmation from the clinic/hospital, do not include it in ERAS! You can always share new information with a residency director during an interview.

There are other ways to get USCE. For example, many graduates of the Universidad Autonoma de Guadalajara in Mexico and similar schools have completed the Pre-Internship Program (originally called "Fifth Pathway") at New York Medical College. If you are not a graduate of UAG but you think you meet the program's criteria, I encourage you to contact NYMC for more information. Training there typically starts in either July or January; if you start in July 2013 then you should be able to get several LORs from American doctors in plenty of time to support your 2013-2014 residency application.

Speaking of UAG, there's a great article in the May 13, 2013 issue of The New Yorker about Elmhurst Hospital in New York, and it specifically focuses on diagnostician and clinical educator Dr. Joseph Lieber, who is a graduate of Universidad Autonoma de Guadalajara. He is incredibly knowledgeable, well-respected, and inspirational. Imagine the main character from the television show House, but loved by everyone. Here is a link to the first few paragraphs of the article; if you have access to a library where you can read the entire article, I encourage you to do so. It will inspire you and could be a useful topic of conversation during a residency interview.

As always, please contact me if you have any questions about the residency application process. I am happy to provide a free assessment of your application. I can help you develop your personal statement and CV, advise you about your strengths and weaknesses, and much more!

NRMP / SOAP schedule

Good luck to all of my clients and to residency applicants from around the world! Here's what the NRMP has posted as this week's Match and SOAP schedule (all times are Eastern):

Supplemental Offer and Acceptance Program (SOAP) starts on 03/11/2013

Monday

Send Applicant and Program Match results to ERAS before 12:00 p.m.

11:30 a.m. Schools: Unmatched Seniors Report (R3 System)

12:00 p.m. Programs Did I Fill? by email and R3 System

12:00 p.m. Applicants: Did I Match? by email and R3 System

12:00 p.m. List of Unfilled Programs (R3 System)

12:00 p.m. Regional Match Statistics (R3 System )

1:00 p.m. ERAS opens in SOAP-mode

2:00p.m. ERAS begins sending applications; only eligible applicants can send

applications and only to unfilled match-participating programs

Program-initiated telephone communications between applicants and programs

may begin, but no offers allowed

Tuesday

Applicants and programs communicate by program-initiated telephone interviews

11:30 a.m. Programs can begin preference list in R3 System

Wednesday

11:55 a.m. Program preference list certification deadline for first offer round

12:00 p.m. Electronic offers extended using R3 System

12:00 p.m. School Report on seniors who accepted positions through SOAP

available and updated continuously.

2:00 p.m. Deadline for Applicants to accept / reject offers

2:55 p.m. Deadline for programs to add to and certify preference list for next round

3:00 p.m. Electronic offers extended using R3 System

5:00 p.m. Deadline for Applicants to accept/reject offers

Thursday

Offers extended every three hours beginning at 9:00 a.m. with last offers valid

3:00-5:00 p.m., using same update schedule noted on Wednesday

8:00 a.m. Schools: Match Notification Letters (R3 System)

8:00 a.m. Schools: Electronic Match Results (R3 System)

8:00 a.m. Schools: Match Results (R3 System)

8:00 a.m. Schools: Applicant Choices by Specialty (R3 System)

8:00 a.m. Advance Data Tables (R3 System)

2:00 p.m. Programs: Roster of Matched Applicants (R3 System)

SOAP Schedule

Main Residency Match - 2013 Main Residency Match

Friday

Match Day!

Offers made every three hours beginning at 9:00 a.m. with last offers valid 3:00-5:00

p.m., using same update schedule noted on Wednesday

12:00 p.m. School Ceremonies

1:00 p.m. Applicants: Where Did I Match? (R3 System)

3:00 p.m. ERAS SOAP-mode ends

List of Unfilled Programs posted through May 1 (R3 System)

Monday

12:00 p.m. Match Outcome for All Programs (R3 System)

12:00 p.m. Match Results by Ranked Applicant (R3 System)

12:00 p.m. SOAP Results by Listed Applicant (R3 System)


If you didn't match and can't find a program through SOAP, I encourage you to read one of my earlier blog posts. Please get in touch with me - we can work together to find you the residency program you've been dreaming of!

How the NRMP Match algorithm works

Are you curious how the Nobel Prize-winning NRMP Match algorithm works? Here's my example highlighting the story of three students:

Students Alice, Ben, and Carlos apply to various numbers of IM programs through ERAS. Alice gets ten interviews, Ben gets zero, and Carlos gets two. Again, the NRMP has no idea how many. Alice has some good and some bad interviews, but decides to rank all programs. Ben ranks a dozen programs that he wants to go to, even though none of them interviewed him. Carlos only ranks one program (which happens to be a program that both Alice and Ben have ranked).

The IM program at Tufts will hire five residents, and ranks fifty applicants who interviewed there. Among other people, it ranks Alice at number 6, Carlos at number 14, and doesn't rank Ben at all (unsurprisingly since they didn't interview him). Alice ranked Tufts at number 4, Ben ranked it at number 2, and Carlos ranked it at number 1.

Match algorithm time. Ben has only ranked programs that don't have him on their lists. No matter how many he tries to rank, there's no possibility of a corresponding match, so he ends up unmatched.

The algorithm tries to match every applicant to their top choice and does not "count" how many programs they actually ranked. If an applicant's top choice has an open slot immediately, the match happens. Because Carlos has 13 people ahead of him at Tufts fighting for those five slots, there's no way that the first iteration will work for him. Alice also fails to match at her top choice (Harvard), and let's say that all of the spots there were instantly filled.

On the second algorithm iteration, Alice's top choice of Harvard is completely blocked. Her #2 choice (Stanford) automatically becomes her new #1...the program will not try to match her at Harvard again because it's impossible. It tries and failed to match her this time, but not all Stanford spots are full, so hope isn't lost yet. Concurrently, the algorithm tries to match Carlos to Tufts. He doesn't get matched this time either, but he's moved up to #12, since one person higher than him near the top of the Tufts list matched to her own top choice somewhere else. Interestingly, Alice is now at #5 on the Tufts list, which means the spot is potentially hers, but the algorithm hasn't tried matching her there yet.

A few algorithm iterations later, and Alice's second choice is full without her matching there, Tufts has matched three people out of five, and all of our heroes are still waiting...though it's just been a few microseconds.

A few more iterations and Alice's third choice (UCSF) is full. Carlos moved up a couple of spots. Tufts has matched its original first, second, and fourth choices, with the third matching elsewhere. Alice and the person originally in the ninth rank now have spots "held" for them due to the original fifth, seventh, and eighth on the list matching elsewhere, and the two of them moving up the ladder.

On the next iteration, Alice matches to Tufts. It's her fourth choice, but it was "virtually" her top choice since the three programs above it filled and she had no chance of matching there. She takes the fourth spot. 

A couple more iterations later and the fifth spot is filled (that man had ranked another program higher, and his spot at Tufts was "held" for him while that other match tried and failed to happen). Carlos is unmatched since Tufts was the only program he ranked. Interestingly, the other program he interviewed at had ranked him quite highly, and he would have matched there if he had bothered to rank it. Ben never had a chance of matching since he didn't interview and no programs ranked him. Both men can try to find a spot through the Scramble/SOAP.

And thus concludes a *very* realistic scenario. The NRMP has their own sample scenario on their website if you want to read it.

My congratulations go out to the creators of the current NRMP Match algorithm, who recently won the 2012 Nobel Prize in Economics! Click here for a short and accessible description of this achievement, and click here for the full journal article about the algorithm's history and development.

September 15 is not the ERAS application deadline!

September 15 is not the ERAS application deadline! Although it is the first day that you can send out your applications, you are not required to do so. Residency program directors will be downloading applications throughout the rest of the month until they can retrieve the MSPEs on October 1, and quite possibly even beyond that date.

What does this mean? Instead of submitting a poorly edited personal statement and an incomplete Common Application Form on the 15th, you should take the time to have your application professionally reviewed. Residency directors don't need your application immediately; they would prefer that you take your time and submit your best effort later this month.

I've been supporting medical students since January 2001, and I would be happy to share more than eleven years' worth of expertise with you. I will give you feedback on your personal statement and ERAS application, and if you'd like, I can go deeper and tell you how residency directors might react to your MSPE and letters of recommendation too. Please contact me for a free consultation. It's not too late to have the residency application you deserve!

Professional Memberships & Associations

One of my clients recently asked me whether joining professional groups could help her application. She also wanted to know if joining both the American College of Physicians and the American Academy of Family Physicians would help or hurt since they're focused on different specialties.

First, I think that it's most important to question why you are joining a group. Are you still in medical school and you want to learn more about residency in a certain profession? Great; you should definitely join! Are you a graduate who has decided on a field of interest and you want to interact with other professionals? That's another great reason to join.

Or are you only joining this group in order to list it on your CAF? If so, that is a bad reason and you might not want to do this at all. Padding your resume with groups that you've joined simply to impress program directors might actually cause you trouble. What would you do during an interview if someone asked you "Why did you join this group?" You'd have to say that you only joined to strengthen your application. That's not enough.

So before you join, think about what you can get out of these groups. Are you planning to attend conferences, read their journals, collaborate with or learn from members, make professional connections, and learn more about those fields? If you can honestly answer "yes" to some of those, and you will be able to comfortably describe your involvement if asked about it during an interview, then joining might be the right idea after all.

As for joining two different associations, remember that anything you list on your CAF will be seen by all programs you apply to, so FM programs will know that you joined the ACP, and IM programs will know that you joined the AAFP. Is that a bad thing? Not necessarily, since many people openly apply in both FM and IM, and both give you the potential to explore what it means to be a physician in a society increasingly concerned with primary care medicine. But if you're applying in both surgery and psychiatry, but don't want the program directors to know that you're doing that, then listing the American College of Surgeons and the American Psychiatric Association on your CAF might hurt you.

As always, please contact me directly, and I can discuss your specific application during a free consultation. There's no single answer to these questions or for any issues relating to your residency application; let me come up with a customized approach for you.

The Residency Application Timeline

The 2012-2013 residency application cycle is about to begin! If you're applying for the first time, or even if you've gone through this process before, these are the crucial dates that you should be aware of. Please note that several of these dates have changed from previous years:

• July 1, 2012 – ERAS opens its MyERAS website. First, you must request your login token (American medical students and graduates should talk to their deans; international graduates should use the ECFMG/OASIS site). After you register with your token, you can start editing your resume into the Common Application Form style used in ERAS, which not only means adding your educational and USMLE history, but more importantly means changing resume bullet points into full well-written paragraphs for each of your volunteer, work, leadership, and research experiences. You can also work on your personal statement, start requesting letters of recommendation (there's a form to print out for your writers), select programs and specialties, and much more. There's a lot to do and not very much time to accomplish it all, especially since you're studying for the USMLE, completing rotations or observerships, and worrying that your writing isn't as strong as it could be. You only get one chance to have your application make a great first impression! Many applicants realize that it's a great idea to find a residency support professional to help during this time. Please contact me for a free consultation.

• September 1, 2012 – the NRMP website opens. The NRMP "Match" is processed separately from ERAS. Basically, you use ERAS to select where you hope to interview and to transmit your documents to those programs, but you use the NRMP to rank the programs where you actually get interviews so you can match there. You can save some money by registering for the NRMP early; while you don't need to register on September 1, the last day to register with a discount is November 30, 2012.

• September 15, 2012 – this is the first day you can pay ERAS to transmit your application to residency programs. Many people will apply on this date, but it is not a deadline. It is much better to apply in late September with a fully reviewed and edited application, instead of sending something out with mistakes on September 15. (for those of you who applied last year, this is a later date!) 

• October 1, 2012 – this is the date when your Medical Student Performance Evaluation (the MSPE, also called the "dean's letter") will be transmitted to all programs that you have paid ERAS for. When program directors download your MSPE, they will automatically download all other documents waiting for them, so you should ensure that your letters of recommendation and medical school transcript are in the system already. (for those of you who applied last year, this is an earlier date!)

• November, December, and January – most interviews are scheduled during this time. Be prepared! Review your answers to common interview questions with a professional, and also ask that professional about the flaws in your application (such as failing the boards or taking a lot of time off) since the program directors will ask about those topics too. Even a great ERAS application means nothing if you don't succeed during the interview.

• February 20, 2013 – this is the final deadline to register your rank list with the NRMP. You should rank every single program you interviewed at, unless you would rather be unmatched than go to a specific program. You should rank the programs in the order that you hope to match to each one. Please read this for more information.

• March 11, 2013 – this is the date when everyone who used the NRMP will find out *if* they matched, but not *where* they matched. If you are unmatched, you will be able to try to "Scramble" into open residency programs during this week.

• March 15, 2013 – NRMP Match results are released, so people will finally find out exactly where they are going to be residents.

I know this is a lot to process, so please contact me for a free consultation and I'll help you!

Your NRMP rank list

Tomorrow is the deadline to submit and certify your final rank list with the NRMP. Here are the key points that you should be aware of:

1) You should rank every single program you interviewed at, unless you would rather be unmatched than go to a specific program.

2) You should rank the programs in the order that you hope to match to each one. The NRMP algorithm is skewed in the applicant's favor; it will not hurt you to rank your favorite program first, even if you think you have no chance of matching there.

3) The rank list you submit and certify on the NRMP website is a binding commitment. If you match to a program on your list, that's where you're going.

4) The deadline for submitting and certifying your rank list to the NRMP is 9:00 PM Eastern time on February 22, 2012. However, I strongly suggest that you certify your list well in advance of that deadline. Power failures and bad Internet connections have caused trouble for applicants in the past, and if you don't meet that deadline, there is nothing that anyone can do for you.

UPDATE: Yesterday, I posted the text you see above, and today the NRMP website went down for over two hours (see screenshot below), but they did not change the final rank list deadline. Imagine if you had only set aside those two hours to work on your list!

"Second look" visits

Sometimes you do get a second chance to make a great first impression. A "second look" visit to a residency program can be an amazing way to show just how interested you are. During a second visit, you will be more relaxed and comfortable, and the people you meet will sense that. Typically, it's a chance for the original interviewers to get to know you better in a less stressful setting. Sometimes other faculty members will be there who weren't available during your first interview. At some programs, you might even be able to join a team during rounds.

Not everyone gets invited for a second look; it's a sign that the program director liked you a lot. Remember that the interview process isn't just about you asking for a job; it's about the program trying to convince the right residents to match there. Adding an applicant to a rank list is taken seriously; it's a multi-year commitment, and the program director wants to find residents who will be great long-term additions to the team, both on and off the wards. Although a second interview visit is an added expense, you ought to think of it as an investment in your future, and accept all offers. Remember that even if you aren't invited for a second look, you can also ask to return for a second visit.

Even if you've only interviewed at one or two residency programs in total this year, the residency director doesn't need to know that. Remember, as much as you want to match anywhere, the interviewers will assume that you're evaluating multiple programs, and will try to convince you to rank that program first.

Second look visits are often a good time to ask residents about lifestyle issues (how good/bad is it really), official work hours versus unofficial expectations, would they choose this program all over again if they had the chance, what aspects of the program are their favorites, and all sorts of questions like that. You should ask where people live, how often they hang out outside of work, what kind of things they do in the area, etc. You can also ask about things like maternity leave policies, but that allows the program director to use that information when ranking you, so be very careful. Sometimes asking questions like "Do you have any relatives nearby" will let people tell stories about their own spouses and kids without you sharing information that you legally can't be asked about.

One of my clients was recently invited for a second look visit on a date when she already had a first interview scheduled somewhere else. I'll tell you the same thing that I told her: although second look visits are important, if you need to choose, you should keep your appointment for a first interview. Most of you can't afford to skip any first interviews; you want to visit as many programs as possible to increase your chances of matching. Plus, what reason would you give for rescheduling that first interview? Instead, you should see if there are any other dates available for that second look visit. You can honestly tell the program director that you want to honor the commitment you already made to another program (although you don't need to share specifically where else you are interviewing), but that coming back for a second visit is also a priority for you.

Good luck! Please contact me if I can provide any more information.